#244 Achilles Heel of lateral pelvic lymph node dissection- Dr. Prudvi Raj S., Dr. Avanish Saklani
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Info About This Video
| Name |
#244 Achilles Heel of lateral pelvic lymph node dissection- Dr. Prudvi Raj S., Dr. Avanish Saklani |
| Video Uploader |
Video From Vattikuti Foundation |
| Upload Date |
This Video Uploaded At 18-09-2023 17:14:08 |
| Video Discription |
This is one of the 2023 KS International Innovation Awards videos selected for inclusion in the Vattikuti Foundation - ORSI Humans on the Cutting Edge of Robotic Surgery Conference, October 6, 7 & 8, 2023 in Ghent, Belgium. Posting does not imply that is has been selected as a Finalist, just that the content will be discussed at the Conference.
From the entry:
Abstract
Aims: To demonstrate a crucial step in Lateral Pelvic
Lymph node dissection (LPLND)
Materials-Methods: Robotic Pelvic Lymph node
dissection after short-course radiotherapy and nine
cycles of Folinic acid+5-Fluorouracil+Oxaliplatin
(FOLFOX) in a 35-year-old gentleman diagnosed with
middle third rectal adenocarcinoma.
The patient & attender have given their informed consent.
• •
• •
Results:
There is evidence that LPLND reduces Lateral Local
Recurrence rates(LLR) in patients with suspicious
lateral nodes.
It is essential to clear the complete template of
lateral nodes, especially the inferior vesical nodes,
to achieve a decrease in LLR.
Adipose tissue around the inferior vesical
artery(IVA) is the most frequent site of metastasis.
Very frequently middle rectal artery(MRA) arises
from or forms a common trunk with IVA. The
growing evidence that lymphatics around the MRA
forms the anatomical basis of lateral nodal spread
& the high frequency of MRA arising from IVA
makes these nodes the first echelon of lateral
group of nodes.
Clearing all the nodes while preserving the IVA is
technically & anatomically challenging. The
learning curve for LPLND is relatively longer.
However, preserving nerves and unilateral IVA is
essential to prevent postoperative urinary
dysfunctions.
•
•
• The surgeon controlled stable camera platform & endo wrist technology of the robot allowing seven degrees of freedom, partly helps in overcoming the technical challenges in dissecting this crucial area.
• Besides its recognized ergonomic benefits, robotics enables enhanced vision and dexterity within the narrow confines of lateral space of the pelvis. This allows for precise dissection around vascular and neural structures, better preservation of autonomic nerves, and eventually, a potential for increased nodal yield and improved clearance.
Conclusion: Considering the functional, oncological,
technical & anatomical implications of dissecting the
inferior vesical area, we call it the Achilles heel.
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| Category |
Science & Technology |
| Tags |
Robotic Surgery | Oncology | Dr. Prudvi Raj S. | Dr. Avanish Saklani | Lateral Pelvic Lymph node dissection |
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